Francesco/who-killed-jfk huggingface dataset:
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# SECRET(When Filled In)SECTION E NARRATIVE DESCRIPTION OF MANNER OF JOB PERFORMANCEStress strengths and weaknesses demonstrated in current position. Indicate suggestions made to employee for improvement of his work. Give recommendations for his training. Describe, if appropriate, his potential for development and for assuming greater responsibilities. Amplify or explain, if appropriate, ratings given in SECTIONS B, C, and D to provide the best basis for determining future personnel actions.JUL 21 2 51 PH '59This employee is intelligent, loyal and dedicated to duty. She has an outstanding ability in getting her job assignments accomplished effectively and with a minimum of time and support. She readily accepts responsibility, is a highly efficient worker who thinks clearly and logically. Her knowledge of Headquarters and Field procedures plus her ability to organize her work greatly facilitates the smooth functioning of the Mexican Desk. She has demonstrated a superior comprehension of the numerous and varied projects of the Mexico City Station which has contributed to the overall Headquarters support of the Station's operations. Because of her sound understanding of operations and her outstanding capacity for work, Miss Zehrung has an excellent potential for assuming greater responsibilities. Additional training is dependent upon her future assignments.SECTION F CERTIFICATION AND COMMENTS1. BY EMPLOYEEI certify that I have seen Sections A, B, C, D and E of this Report.DATESIGNATURE OF EMPLOYEE2. BY SUPERVISORIF THIS REPORT HAS NOT BEEN SHOWN TO EMPLOYEE, GIVE EXPLANATIONMONTHS EMPLOYEE HAS BEENUNDER MY SUPERVISION22 monthsIF REPORT IS NOT BEING MADE AT THIS TIME, GIVE REASON.EMPLOYED UNDER MY SUPERVISION LESS THAN 90 DAYSREPORT MADE WITHIN LAST 90 DAYSOTHER (Specify):DATEOFFICIAL TITLE OF SUPERVISORTYPED OR PRINTED NAME AND SIGNATURE13. June 1959C/WH/III/Mexico.John J. Brady3. BY REVIEWING OFFICIALX I WOULD HAVE GIVEN THIS EMPLOYEE ABOUT THE SAME EVALUATION.I WOULD HAVE GIVEN THIS EMPLOYEE A HIGHER EVALUATION.I WOULD HAVE GIVEN THIS EMPLOYEE A LOWER EVALUATION.I CANNOT JUDGE THESE EVALUATIONS. I AM NOT SUFFICIENTLY FAMILIAR WITH THE EMPLOYEE'S PERFORMANCE.COMMENTS OF REVIEWING OFFICIALDATEOFFICIAL TITLE OF REVIEWING OFFICIALTYPED OR PRINTED NAME AND SIGNATURE11 July 1959C/WH/IIIR. DuplerenSECRET
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CONFIDENTIAL(When filled in)NOTE TO PCS RETURNEESPersonnel processing in from a PCS foreign field assignment through Central Processing Branch are required to review the Employee Conduct Handbook and the information for PCS returnees. This information is contained in a notebook provided by the CPB receptionist.MEMORANDUM OF UNDERSTANDINGI hereby acknowledge that I have read and understand the contents of Handbook 20-4, Employee Conduct, dated 9 July 1970 and the information for returnees dated 1 February 1972.CHARLOTTE Z. RUSTEVIDETANAME(Please Print)Charlotte J. Rustevidetia 5 September 1972SignatureDateCONFIDENTIAL(When filled in)Excluded from automatic downgrading and declassification.
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SECRET(Bhen gilled in)# REPORT OF SERVICE ABROADTO: Office of Personnel, Control Division, Statistical Reporting BranchNAMESERIAL NO. LAST FIRST MIDDLE007667 Bustosvidele Charlotte ZINSTRUCTIONSUSE APPROPRIATE SPACE BELOW TO REPORT DATA FOR EITHER PCS OR TOY, INSERT APPROPRIATE CODE NUMBER IN "CODE" COLUMN TO DESIGNATE WHETHER SUBMISSION IS OF DASIC DATA, CORRECTION, OR CANCELLATION (One only), REPORT DATES BY USING THE NUMBER FOR THE MONTH, AND LAST TOO DIGITS ONLY FOR YEAR, PEFER TO OFINO. 38. REVISED.PCS DATES OF SERVICE| ARRIVAL O/S        | DEPARTURE O/S      | TYPE OF DATA                                 | O/P USE ONLY | COUNTRY | CODE  || ------------------ | ------------------ | -------------------------------------------- | ------------ | ------- | ----- || MONTH   DAY   YEAR | MONTH   DAY   YEAR |                                              |              |         |       || 25-26 27-28 29-30  | 31-32 33-34 35-36  | 1. PCS (Basic) 3. CORRECTION 5. CANCELLATION | 37 38 39     | Mexico  | 40-42 ||                    | 081072             |                                              |              | 450     |       |TDY DATES OF SERVICE| ARRIVAL O/S        | DEPARTURE O/S      | TYPE OF DATA                                 | O/P USE ONLY | AREA(S) | CODE || ------------------ | ------------------ | -------------------------------------------- | ------------ | ------- | ---- || MONTH   DAY   YEAR | MONTH   DAY   YEAR |                                              |              |         |      || 25-26 27-28 29-30  | 31-32 33-34 35-36  | 2. TOY (Basic) 4. CORRECTION 6. CANCELLATION | 37 38 39     |         |      |OFFICE OF PERSONNEL USE DALY - PUNCH ARFASOURCE DOCUMENT AND CERTIFICATIONTRAVEL VOUCHEN DISPATCHCABLE OUTY STATUS ON TIME AND ATTENDANCE REPORTOTHER (Specify)DOCUMENT IDENTIFICATION NO. DOCUMENT DATE/PERIODIN 680799 8/10/72REMARKSPREPARED BY REPORT ANNOTATED OM ANGIE DAMA CERTIFIED CORRECT, BASED LEON SOURCECONTROI DOCUMENT DOCUMENT CITEDDATE SIGNATURE5/11/721THIS REPORT WILL BE FILED IN THE OFFICE OF PERSONNEL IN THE INDIVIDUAL'S OFFICIAL PERSONNEL FOLDERSECRET
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# SECRET## FIELD REASSIGNMENT QUESTIONNAIREDO NOT COMPLETE FOR NEADOUARTERS USE OBLYNAME OF EMPLOYEE (use ponuda only if SA) DATE (from item S.D NAME OF SUPERVISI (1100) DATE (from item 5-2)Charlotte Z. Bustos-Videla 8 Sep 1971 John R. Horton 8 Sep 1971DATE RECEIVED AT HEADQUARTERS: DISPATCH NUMBER+ DATE RECEIVED BY CAREER SERVICE:![off logo]15 September 1971 HMNT 11,086, 8 Sep 1971TO BE COMPLETED BY EXPLOYEE1. DATE OF BIRTH 2. SERVICE 3. YOUR CURRENT POSITION, TITLE 4. STATION OR BASE 9. CRYPT FOR   DESION CURRENT COVER12 Jan 29 Cuba/CI; GS-13 Mexico City Nominal LNGOLD64. DATE OF PCB ARRIVAL 80. REQUESTED DATE OF SC. EXPECTED DATE OF FIRST OS, DESIRED DATE TO REPORT TO DUTY    IN FIELD DEPARTURE CHECK-IN AT HO AFTER LEAVE28 July 1967 9 Sept. 1972 ------ 16 October (3 weeks H/L)(2 weeks A/L)7. NUMBER AND AGES OF DEPENDENTS WHO WILL TRAVEL WITH YOUNone8. PERSONAL CIRCUMSTANCES THAT SHOULD HE CONSIDERED IN DETERMINING NEXT ASSIGOMENTMy husband is currently a professor in New York City, and I would very much appreciate an assignment in New York City so I may join him there. I would be agreeable to changing somewhat my departure date from Mexico if it would help in my accepting an opening in New York City. (My reason for requesting the two month extension is to insure my 5 years overseas duty so as to qualify for the organization's retirement plan.)9. LIST YOUR MAJOR DUTIES OURING CUPRENT TOUR (see special note on transmittel form).   (also attach personal cover questionnaire in accordance with CS1-F 240-8)1. Analysis of personality and target data from raw and finished reports, preparation of target studies, and finished intelligence dissems.2. Oporational reporting: cables, dispatches, projects, progress reports, etc.3. Handling of outside transcribers. (off and on).4. Records control and purgo of Station files.5. Preparation of memos for other components of LACUFF.6. General Ops support IA typo work.10. TRAINING DESIRED:    INDICATE WHAT TRAINING YOU BELIEVE YOU SHOULD HAVE DURING THE NEXT SEVERAL YEARSSECRET
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SECRET11. PREFERENCE FOR RENT ASSIGNMENT.11A. DESCRIBE DRIFTLY THE TYPE OF BUR TOU BOULD PTFE FOR ME usut if witFERENT FROM THAT INDICATED IN ITEM NO. 8 ABOVE. IF YOU HAVE MORE THAN ONE PREFERENCE, INDICATE YOUR CHOICE.11B. INDICATE IF YOU DESIRE TO LETEND YOUR CURRENT TOUR BY CHECKING IN APPROPRIATE BOX. ALSO INDICATE PREFERENCE FOR NERT REGULAR ASSIGNMENT DY INSERTING 1, 2, 3 (for Ist, 2nd, and Ird choice) IN REMAINING BOXES. COMPLETE ALL ALTERNATE CHOICES AND OPTIONS IN ALL CASES EVEN THOUGH YOU ARE REQUESTING AN EXTENSION OF YOUR TOUR.*   EXTEND TOUR 2 MONTHS AT CURRENT STATION TO 9 September*   BE ASSIGNED TOORIES FOR A TOUR OF DUTY: INDICATE CHOICE OF DIVISION. EUR WINY OR OFFICE.*   BE ASSIONKO NOW TorkLD STATION, INDICATE CHOICE OF GEOGRAPHIC AREA OR SPECIALIZATION*   RETURN TO MY CURRENT STATIONTO BE COMPLETED BY FIELD STATION12. IN CONSIDERATION OF THE FPERIENCE AND PERFORMANCE OF THE FUPLOYEE AND HIS PREFERENCE FOR NEXT ASSIGNMENT, INDICATE YOUR RECOMMENDATION FOR HIS NEAT ASSIGNMENT AND TRAINING:Those of you who know her realize that I would hardly give up SCALETTI, oven after five years on the job, without a fight, did not other reasons intervene. Her husband is working in New York now and so her romaining here any longer than needed for her to qualify for her retirement time, as she explains, is a needless hardship. (It would holp us if you would confirm that time: is that the date needed for her to remain in order to qualify?) Please do your best to arrange -continuedTO BE COMPLETED BY APPROPRIATE HEREJAPTERS OFFICE13. IN CONSIDERATION OF THE FAPERIENCE AND PERFORMANCE OF THE CUPIGIFE, HIS PREFERENCE FOR NEXT ASSIGNMENT, "AND THE STAFFING REQUIREMENTS OF YOUR COMPONENT, INDICATE VOUND COMPONENT'S PECOMMENDATION FOR HIS NEXT ASSIGNMENT AND TRAINING,Subject will be assigned as chief of the CA Section, WH/Branch One. She is being notified via HMMS 7580.DATE 9Jun72 TITLE DC/WH/Pers SIGNATURE Jane Wurz,FOR USE BY CAREER SEPACE14. APPROVED ASSIGNMENTI15. EMPLOYEE NOTIFIED BY DISPАТЕМ ПО,CAQEER SERVICE REPRESENTATISRISECRET
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12. CONTINUEDan assignment in New York for her. She is such a valuable person that anyone who has worked with her would be glad to have her on the premises: so there is no need to try to "sell" her: it's just the question of whether the timing would be right, I should think.
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# CONFIDENTIALSeglete in original. The data recorded on this form is essential in determining travel expenses allowable in connection with leave at government expense, overseas duty, return to residence upon separation, and for providing current residence and dependency information required in the event of an employee emergency. This form will be filed in the employee's official personnel folder.NAME OF EMPLOYEEBUSTOS-VIDELACharlotteZ069-24-3138## RESIDENCE DATAPLACE OF RESIDENCE WHEN INITIALLY EMPLOYED BY AGENCYWashington, D.C.LAST PLACE OF RESIDENCE IN CONTINENTAL U.S.Washington, D.C.PLACE IN CONTINENTAL U.S. DESIGNATED AS PERMANENT RESIDENCEDayton, OhioHOME LEAVE RESIDENCEDayton, Ohio.## MARITAL STATUSSINGLEX MARRIEDSEPARATEDDIVORCEDWIDOWEDANNULLEDIF MARRIED, PLACE OF MARRIAGEDayton, OhioDATE OF MARRIAGEMarch 18, 1261IF DIVORCED; PLACE OF DIVORCE DECREENADATE OF DECREEWIDOWED, PLACE SPOUSE DIEDNADATE SPOUSE DIEDIF PREVIOUSLY MARRIED, INDICATE NAME(S) OF SPOUSE, REASON(S) FOR TERMINATION, AND DATE(S)NA## MEMBERS OF FAMILYNAME OF SPOUSECesar Custos-VidelaADDRESSApartedo Postal 6-940, Mexico 6, D. F. MEXICOTELEPHONE NOMEXICO CIT.525-42-36NAMES OF CHILDRENADDRESSSEXDATE OF BIRTHNANAME OF YOUR FATHERSamuel D. ZehrungADDRESS425 Dayton Towers Dr, Dayton, OhioTELEPHONE NO.51-222-0750NAME OF YOUR MOTHERNazel ZehrungADDRESSTELEPHONE NO.WHAT MEMBER(S) OF YOUR FAMILY. IF ANY, HAS BEEN TOLD OF YOUR AFFILIATION WITH THE ORGANIZATION IF CONTACT IS BE-QUIRED IN AN EMERGENCY..Same## PERSON TO BE NOTIFIED IN CASE OF EMERGENCYNAMECesar Bustos-VidelaRELATIONSHIPhusbandHOME ADDRESSsee aboveHOME TELEPHONE NUMBERsee aboveBUSINESS ADDRESSUniversidad de las Americas, Puebla, MEXICOBUSINESS TELEPHONE & EXTENSIONIS THE INDIVIDUAL NAMED ABOVE WITTING OF YOUR AGENCY AFFILIATIONyesYESXNOIS THIS INDIVIDUAL AUTHORIZED TO MAKE DECISIONS ON YOUR BEHALF IN THE EVENT YOU ARE INCAPABLEYESXNODOES THIS INDIVIDUAL KNOW THAT HE HAS BEEN DESIGNATED AS YOUR EMERGENCY ADDRESSEE?YESXNOThe persons named in item 3 above may also be notified in case of emergency. IF SUCH NOTIFICATION IS NOT DESIRABLE BECAUSE OF HEALTH OR OTHER REASONS, PLEASE SO STATE IN ITEM 6 ON THE REVERSE SIDE OF THIS FORM.CURRENT RESIDENCE AND DEPENDENCY REPORTCONFIDENTIAL
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CONFIDENTIAL(When Filled In)VOLUNTARY ENTRIESExperience in the handling of employee emergencies has shown that the absence of certain personal data often delays and complicates the settlement of estate and financial matters. The information requested in this section may prove very useful to your family or attorney in the event of your disability or death and will be disclosed only when circumstances warrant.INDICATE NAME AND ADDRESS OF ANY BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS AND THE NAMES IN WHICH THE ACCOUNTS ARE CARRIED.All financial information is on file with our lawyerMr. John DAHLGRENDAHLGREN DARRAGH & CLOSE1000 Corn. Ave., N.W... Washington D.C.ARE YOU A MEMBER OF THE NORTHWEST FEDERAL CREDIT UNION?YESNOIF YES, DO YOU HAVE A JOINT ACCOUNT?YESNOHAVE YOU COMPLETED A LAST WILL AND TESTAMENT?YESNO. (If "Yes" where is document located")On file with lawyer listed aboveHAVE YOU PREPLANNED AN ARRANGED QUARDIANSHIP OF YOUR CHILDREN IN CASE OF COMMON DISASTER TO BOTH PARENTS!YESNO. (If Yes" give name(s) and address)NAHAVE YOU EXECUTED A POWER OF ATTORNEY?YESNO. (If Yoe", who possess the power of attorney?)Believe the lawyer has this alsoADDITIONAL DATA AND/OR CONTINUATION OF PRECEDING ITEMS
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CONFENTIAL(When Filled In)MEMORANDUM OF UNDERSTANDINGI hereby acknowledge that I have read and understand the contents of Handbook 20-4, Employee Conduct, dated 7 October 1963, and the information brochure for PCS returnees, dated liay 1964.![Signature]SignatureBUCTOS Adelu, CharlotteCONFIDENTIAL(When Filled In)22 Dec 1970Date
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# SECRETFIELD REASSIGNMENT QUESTIONNAIRE|                                           |                                           || ----------------------------------------- | ----------------------------------------- || DO NOT COMPLETE                           | FOR HEADQUARTERS USE ONLY                 || NAME OF EMPLOYEE (Use pseudo only if SA)  | DATE (from item 5.1)                      || Charlotte Bustos-Videla                   | James B. Noland                           || DATE RECEIVED AT HEADQUARTERS:            | DATE RECEIVED BY CAREER SERVICE:          || 2 Feb. 1970                               | 26 Jan, 19.0                              || DISPATCH NUMBER:                          | DATE (from item 5.2)                      || HMMT-10102                                | 26 Jan, 70                                || TO BE COMPLETED BY EMPLOYEE               | 10 APR 1970                               || 1. DATE OF BIRTH                          | 8. SERVICE DESIGN                         || 12 Jan 29                                 | Exec Assistant, GS-13 MEXICO CITY Station || 04. DATE OF PCB ARRIVAL IN FIELD          | 68. REQUESTED DATE OF DEPARTURE           || 28 July 1967                              | 16 Aug 1970                               || 3. YOUR CURRENT POSITION, TITLE AND GRADE | 5. CRYPT FOR CURRENT COVER                ||                                           | Tourist                                   || 6C. EXPECTED DATE OF FIRST CHECK-IN AT HQ | 6D. DESIRED DATE TO REPORT TO DUTY        || Will not go Hdqs unless requested         | 26 Oct 1970                               |7. NUMBER AND AGES OF DEPENDENTS WHO WILL TRAVEL WITH YOU:none8. PERSONAL CIRCUMSTANCES THAT SHOULD BE CONSIDERED IN DETERMINING NEXT ASSIGNMENT:Subject wishes to remain overseas for a minimum of two more years to complote her 5 years overseas requirement.9. LIST YOUR MAJOR DUTIES DURING CURRENT TOUR (see special note on transmittal form). (also attach personal cover questionnaire in accordance with C51-F 240-8)1.  During most of Subject's tour in Mexico she has been the Cuban IA. In this job she also handled some Cuban operational matters including two outside contract employees.2.  During this period she also handled some sensitive projects for the CCS.3.  During the last six months Subject has been Exec Asst to the COS/DCOS concentrating on file and administrative recrganization of the Station.4.  Subject has had supervisory responsibility over one to three clerical/TDY staff for short periods.10. TRAINING DESIRED: INDICATE WHAT TRAINING YOU BELIEVE YOU SHOULD HAVE DURING THE NEXT SEVERAL YEARSNone
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SECRET11. PREFERENCE FOR MERT ASSIGNMENT11A. DESCRIBE BRIEFLY THE TYPE OF WORK YOU WOULD PREFER FOR NEXT ASSIGNMENT IF DIFFERENT FROM THAT INDICATEDIN ITEM NO. 9 ABOVE. IF YOU HAVE MORE THAN ONE PREFERENCE, INDICATE YOUR CHOICE.I enjoy both Administrative and Ops, IA work.11B. INDICATE IF YOU DESIRE TO EXTEND YOUR CURRENT TOUR BY CHECKING IN APPROPRIATE BOX. ALSO INDICATE PREFERENCEFOR NEXT REGULAR ASSIGNMENT BY INSERTING 1, 2, 3 (for 1st, 2nd, and 3rd choice) IN REMAINING BOXES.COMPLETE ALL ALTERNATE CHOICES AND OPTIONS IN ALL CASES EVEN THOUGH YOU ARE REQUESTING AN EXTENSION OF YOURTOUR.3 ☐ EXTEND TOUR: 12 MONTHS AT CURRENT STATION TO Aug 1971☐ BE ASSIGNED TO HOOTRS FOR A TOUR OF DUTY: INDICATE YOUR CHOICE OF DIVISION, STAFF OR OFFICE.1ST CHOICE 2ND CHOICE 3RD CHOICE1 ☐ BE ASSIGNED TO ANOTHER FIELD STATION, INDICATE CHOICE OF GEOGRAPHIC AREA OR SPECIALIZATION1ST CHOICE Paris 2ND CHOICE 3RD CHOICE2 ☐ RETURN TO MY CURRENT STATION for 2nd tour.TO BE COMPLETED BY FIELD STATION12. IN CONSIDERATION OF THE EXPERIENCE AND PERFORMANCE OF THE EMPLOYEE AND HIS PREFFRENCE FOR NEXT ASSIGNMENT,    INDICATE YOUR RECOMMENDATION FOR HIS NEXT ASSIGNMENT AND TRAININGIWould not stand in Subject's way, were she to be fortunate enough to get a Paris assignment. However with her long Mexico background (both Hugs and field) and her multiple talents she has been invaluable in the reorganization of this highly complicated Station under changed circumstances, will continue to be so during the next several years and to lose her would be like losing one's right arm. Therefore we strongly endorse either a second tour or an extension.TO BE COMPLETED BY APPROPRIATE HEADQUARTERS OFFICE13. IN CONSIDERATION OF THE EXPERIENCE AND PERFORMANCE OF THE EMPLOYEE HIS PREFERENCE FOR NEXT ASSIGNMENT, AND THE STAFFING REQUIREMENTS OF YOUR COMPONENT, INDICATE YOUR COMPONENT'S RECOMMENDATION FOR HIS NEXT ASSIGNMENT AND TRAINING.WI Division recommends that subject return to Mexico City for a second tour.DATE 11 Mar 70 TITLE C/Hd/Pars SIGNATURE Henry L. BertholdFOR USE BY CAREER SERVICE14. APPROVED ASSIGNMENTNew tour in Mexico CityDATE:DATE:DATE:SECRET
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CONFIDENTIALComplete in original. The data recorded on this form is essential in determining travel expenses allowable in con-nection with leave at government expense, overseas duty, return to residence upon separation, and for providing current residence and dependency information required in the event of an employee emergency. This form will be filed in the employee's official personnel folder.NAME OF EMPLOYEE (Last) (First) (Middle) SOCIAL SECURITY NUMBERBUSTOS VIDELA Z. 669-21-51381. RESIDENCE DATA   PLACE OF RESIDENCE WHEN INITIALLY EMPLOYED BY AGENCY LAST PLACE OF RESIDENCE IN CONTINENTAL U.S. (If appointed abroad)   WASHINGTON DC. N.APLACE IN CONTINENTAL U.S. DESIGNATED AS PERMANENT RESI- HOME LEAVE RESIDENCEWASHINGTON DC. Dayton, Cleveland Ohio2. MARITAL STATUS (Check one)   SINGLE [X] MARRIED SEPARATED DIVORCED WIDOWED ANNULLEDIF MARRIED, PLACE OF MARRIAGE DATE OF MARRIAGEDAYTON, OHIO March 18, 1961IF DIVORCED, PLACE OF DIVORCE DECREE DATE OF DECREENAIF WIDOWED, PLACE SPOUSE DIED DATE SPOUSE DIEDNAIF PREVIOUSLY MARRIED, INDICATE NAME(S) OF SPOUSE, REASON(S) FOR TERMINATION, AND DATE(S)NA3. MEMBERS OF FAMILY   NAME OF SPOUSE ADDRESS (No Street, City, State, Zip Code) TELEPHONE NO.   CESAR Bustos-Videla LAS AMERICAS UNIV., MEXICO CITY, MEXICO   NAMES OF CHILDREN ADDRESS SEX DATE OF BIRTH- NAME OF YOUR FATHER (or male guardian) ADDRESS 27, Dalton tr 25Samuel D. Zehrung Dayton OhioNAME OF YOUR MOTHER (or female guardian) ADDRESSHazel J. Zehrung SameWHAT MEMBER(S) OF YOUR FAMILY IF ANY, HAS-BEEN TOLD OF YOUR AFFILIATION WITH THE ORGANIZATION IF CONTACT IS RE-QUIRED IN AN EMERGENCY.Emily Zehrung, all my family, I am a resident of July 67.4. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY   NAME (Mr., Mrs., Miss) (Last-First-Middle) RELATIONSHIP HOME TELEPHONE NUMBER   Mrs. Pelaumer, Mary Elizabeth (MW Dale) Sister 5137410HOME ADDRESS (No Street, City, State, Zip Code) BUSINESS TELEPHONE & EXTENSION576 Lake Forest Drive, Bay Village, Ohio 44140 216-871-0689BUSINESS ADDRESS (No., Street, City, State, Zip Code) AND NAME OF EMPLOYER, IF APPLICABLEIS THE INDIVIDUAL NAMED ABOVE WITTING OF YOUR AGENCY APFILIATION? (If "No" give name and address of organization he/she believes you work for)My will to work for govt.IS THIS INDIVIDUAL AUTHORIZED TO MAKE DECISIONS ON YOUR BEHALF IN THE EVENT YOU ARE INCAPABLE? (If "No" give name and address of person, if any, who can make such decisions in case of emergency.)Lawyer or physician may makeDOES THIS INDIVIDUAL KNOW THAT HE HAS BEEN DESIGNATED AS YOUR EMERGENCY ADDRESSEE? (If answer is "No" explain why in item 6.)The persons named in item 3 above may also be notified in case of emergency. IF SUCH NOTIFICATION IS NOT DESIRABLE BE-CAUSE OF HEALTH OR OTHER REASONS, PLEASE SO STATE IN ITEM 6 ON THE REVERSE SIDE OF THIS FORM.CONTINUED ON REVERSE SIDECURRENT RESIDENCE AND DEPENDENCY REPORTCONFIDENTIAL
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# CONFIDENTIAL(When Filled In)-VOLUNTARY ENTRIESExperience in the handling of employed emergencies has shown that the absence of certain personal data often.delays and complicates the settlement of estate and financial matters. The information requested in this section may prove very useful to your family or attorney in the event of your disability or death and will be disclosed only whencucumstances warrant.INDICATE NAME AND ADDRESS OF ANY BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS AND THE NAMES IN WHICH THE ACCOUNTS ARE CARRIED.The Naternal Bank of Woslengten., Supont Curse Brause, Washington Üßjoint account with husbandColumbia fuerat Saving, Loan Assoc, 5:01. Jise Ave.n.w. 0.0.joint sscoun's with busband.ARE YOU A MEMBER OF THE NORTHWEST FEDERAL CREDIT UNION?IF YES, DO YOU HAVE A JOINT ACCOUNT?HAVE YOU COMPLETED A LAST WILL AND TESTAMENT?Lawyer: Ms. John O. LahlgrenBahtyers Barsaros Close1000 Uurmar ave. n.w.HAVE YOU PREPLANNED AN ARRANGED GUARDIANSHIP OF YOUR CHILDREN IN CASE OF COMMON DISASTER TO BOTH PARENTS?YES NO. (Il "Yes" givo name(s) and address)HAVE YOU EXECUTED A POWER OF ATTORNEYTfor accrying levels. The Natiinst Bank of Washington, d.C.ADDITIONAL DATA AND/OR CONTINUATION OF PRECEDING ITEMSSIGNED ATDATE SIGNATUREJune .28 1967 Cliem J. Luster indiaeCONFIDENTIAL